Engaging in risk-based contracts? Get an actuary’s opinion

Health care providers across the country are looking at ways they can increase their clinical and financial risk exposure under value-based contracts. But if they’re not experienced with risk, they may enter into contracts that put them in difficult situations. The consequences of bad risk contracts could include poor cash flows, non-competitive rates resulting in […]
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Positioning for continued growth in public exchanges

Most payers competing in federally facilitated marketplaces or state-based exchanges are past the initial stages of implementation. Now is the time for payers to think about taking their plans to a new level, with greater consumer-oriented offerings and engagement approaches — supported by efficient operations, sophisticated data analytics and risk modeling. What are some areas […]
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Provider executives share insights on the evolution of population health

How can you adapt to population health? If you’re a health care provider, such a question can’t be answered in a sentence or a paragraph—or even an entire article. But providers who are undergoing a fee-for-service to fee-for-value transformation have offered some insight into how and why they’re evolving to become excellent at managing the […]
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Sentara Medical Group puts improved predictive modeling into action

In a recent post, we discussed usability factors in predictive analytics. Today’s final post in the predictive analytics series will discuss an example of a provider that has used prediction to inform its population health management program. Predicting hospitalizations helps Sentara practice proactive care. Sentara Medical Group has 380 primary and specialty care physicians in […]
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Ten principles to help you engage providers around ICD-10

With less than three months until the ICD-10 go-live date, you may still be having trouble engaging providers around the new code set. If so, that’s not surprising. While we know that patient care will ultimately benefit from ICD-10’s increased specificity and data detail, doctors are focused on the here and now. And frankly, they […]
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Preparing your business for technology change: Nine essential readiness activities

In last week’s blog, we discussed the benefits and risks associated with major technology change. This week we offer perspective on the nine essential readiness activities that will help you prepare for major technology change. It’s important to realize that these nine activities: Do not need to be performed in order Are mutually exclusive Can […]
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Use big data and analytics to slow health care costs and compete on outcomes

By: The Optum Risk & Quality Solutions Team Health care is awash in data, so one might think that providers and payers would be on the forefront of the big data movement. While it’s true that claims data has been used for various purposes, including epidemiological research and predictive modeling, it doesn’t have the richness […]
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Pay-for-value can improve behavioral health care

Paying for value not only helps drive improvements in behavioral health care and lower costs. It also inspires innovation in treatment and empowers consumers. Today at Optum, nearly 20 percent of our total spending on inpatient network-based behavioral health is tied to performance-based contracts. These contracts reward providers for collaboration, better patient outcomes and improved […]
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Readiness activities to prepare your business for technology change

Across the health care industry, payers are asking themselves if their technology platform is ready for the future. There are two avenues to explore where technology change is concerned – either upgrade your existing system or completely overhaul it. The drivers behind technology change can determine the extent to which change needs to happen. Complex […]
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Vantage Cancer Care Network makes risk work in specialty care

The pay for value revolution is here, and it means significant changes to the way primary care is provided to patients. But what does it mean for specialists? In risk-based contracts, primary care providers such as family physicians, pediatricians, OB/GYNs and internists are relied on to keep patients healthy and well. Meanwhile, the industry is […]
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